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HTN-GI-Analgesics
GWCC Block 1 nursing
| Question | Answer |
|---|---|
| 6 anti-HTN clases of drugs | ACE-inhibitors, ARB's, Beta-blockers, CCB's, Diuretics, Vasoconstrictors |
| What do ARB's do? | affect adrenal gland (--> aldosterone) and vascular smooth muscle. |
| ARB's end in . . | -sartan |
| Which HTN drug causes a cough and which similar one does not? Why? | ACE inhibitors cause a cough because they are not selective in stopping angiotensin 1 and angiotensin 2. ARB's do not cause the cough because they are more specific with their target (aldosterone) |
| What do CCB's do? What are they mainly used for? | they act to decrease (relax) smooth muscle tone, and to decrease SVR. They are also used for antidysrhythmics, and to treat angina (in addition to HTN) |
| How do diuretics work to decrease HTN? | They lower blood volume, which decreases heart preload, which decreases cardiac output and decreases peripheral vascular resistance. |
| The most common diuretic used to treat HTN is . .. | hydrochlorothiazide |
| What are the types of beta blockers? | Non-selective B blockers work on both B1 (heart) and B2 (lung/peripheral) receptors. Selective work on B1 only. |
| What is the effect of B blockers? | They decrease cardiac contractility, decrease HR, which decreases cardiac output. They also cause vasoconstriction. |
| Which type of B blockers should not be used for asthmatics? | non-selective B blockers |
| What do B blockers end with? | -olol |
| How to ACE-inhibitors work? | The block ANGIOTENSIN in the RAA system. This decreases Na and H2O reabsorption which decreases blood volume (SVR), and that decreases afterload of the heart. It also acts on the vascular system to increase dilation of blood vessels. |
| What are fast-acting vasodilators used for? | hypertensive emergencies |
| BP = | BP = CO x SVR |
| Normal blood pressure | below 120 / 80 |
| Pre-HTN blood pressure | 120-139 / 80-90 |
| Stage 1 HTN | 140- 159 / 90-100 |
| Stage 2 HTN | 160+ / 100+ |
| How does HTN affect the kidneys? | Thickens blood vessels so wastes build up and cause kidney damage. |
| What systems regulate blood pressure (2)? | 1) SNS. When activated, causes vasoconstriction, fast HB 2) Renin-angiotensin-aldosterone system |
| Angiotensin II: | a powerful vasoconstrictor |
| Aldosterone causes: | the kidneys to retain Na and H2O, which raises BP. |
| The RAA is triggered by | low BP, low blood volume. It causes vasocontriction and increased fluid volume of the blood by holding onto Na and H2O. |
| Thiazide diuretics (a) used for (b) act on | (a) first try for HTN (b) act mainly on distule tubule to inhibit Na resorption |
| What are some lab values affected by thiazide diuretics? | -Hyponatremia and fluid depletion -Hypokalemia -Hypomagnesia -Hypotension -Hyperuricemia -Hypercalcemia |
| What might be given to a patient who is taking thiazide diuretics? | supplement potassium and magnesium |
| What are the common side effects of thiazide diuretics? | -dizziness, hypotension, GI upset, frequent urination, photosensitivity. |
| How do ACE inhibitors work? | ACE inhibitors stop or inhibit the activation of angiotensin-converting enzyme, which changes angiotensin I to angiotensin II. Angiotensin II will cause vasocontriction, so ACE *inhibitors* cause vasodilation. |
| ACE inhibitors are good for pt with these conditions because . . . | CHF and diabetes, because they protect the kidneys from damage. Also good for patients with heart failure because it slows progression of left ventricular hypertrophy after an MI. |
| Most ACE inhibitors are PRODRUGS. These drugs would not be good for people with ____. The 2 exceptions are . . | Liver conditions. The two exceptions that are not prodrugs are captopril and lisinopril. |
| The major adverse effects of ACE inhibitors are (3) | hypotension hypokalemia dry cough |
| When first giving an ACE inhibitor, this symptom may occur, but will not last. | Hypotension |
| How do ARBs work? | They allow angiotensin I to be converted into angiotensin II, but block the angiotension II receptors. This blocks vasocontriction, and release of aldosterone. |
| What do ARB's end with? | -sartan |
| Who uses ARB's mostly? | Patients who cannot tolerate ACE inhibitors |
| How do CCBs work? | The cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle cx. This causes decreased peripheral smooth muscle tone and decreased systemic vascular resistance. |
| Beta blockers are contra-indicated in these patients: | severe bradychardia, heart blocks, asthma, heart failure |
| How do Beta blockers work? | The block B-receptors in heart and lungs, which blocks the SNS reactions. They decrease cardiac contractility and vasoconstriction. |
| When giving B-blockers watch for___. | blood sugar- Bblockers cause HYPERglycemia, and blocks hypoglycemia symtoms. Watch orthostatic hypotension. |
| Receptors of the SNS: A B1 B2 | A: cause vasoconstriction B1: cause increased HT and contractility B2: cause bronchodilation and peripheral vasodilation |
| What are some adverse effects of Bblockers? | hypotension, bradycardia, fatigue, insomnia, sexual dysfunction |
| Beta blockers cause ___ unless they are cardoselective, such as the drug ___. | bronchoconstriction, Metoprolol |
| Beta blockers can worsen ___ | CHF. |
| B Blockers end with . . | -OLOL |
| Direct-acting vasodilators, which are used for hyptertensive emergencies, act on____. | smooth muscles of the blood vessels. |
| Examples of drugs used for hypertensive emergencies (2) | - Hydralazine (Apresoline) - Nitroprusside (Nipride, Nitropress) |
| Why should HTN not be stopped abruptly? | Can cause a rebound hypertensive crisis. Oral forms given with meals so absorption is more gradual and effective. |
| Of the HTN meds, ____ are more effective in caucasions, and ___ are more effective in African-americans. | B-blockers and ACE inhibitors more effective in caucasions, CCB's and diuretics more effective in african-american patients. |
| Alpha receptors affect ___. | nerve locations (tissue, muscles, organs) which causes vasocontriction. A1 *blockers* cause vasodilation. A2 *agonists* cause lower BP. |
| What are some uses for opiod drugs? | pain, sedation, anxiety, acute pulmonary edema (opiods cause vasodilation), suppress cough, treat diarrhea. |
| Three ways that opioids act (three forms of opioid drugs) | 1) agonist- activate mu and kappa receptors 2) partial agonist- produces low to moderate receptor activation when used alone, but will block the actions of full agonist if two drugs used together. 3) antagonist- blocks activation of mu and kappa |
| Advantages of opioids vs other analgesics | no standard dose, no ceiling dose-- depends on patient's tolerance level |
| Addiction is characterized by ___ | impaired control over drug use, compulsive use, continued use despite harm, and craving. Euphoria. |
| What is the first sign of tolerance to pain meds? | decreased duration of drug effectiveness |
| When giving PCA, it is important to | monitor patients respiratory and sedation level for the first 12-14 hours |
| What is the advantage of using fentanyl? | more potent than morphine but less respiratory depressive effects |
| what are contraindications of using opioids/narcotics? | increased ICP, pregnancy, pulmonary disease, cirrhosis, hypothyroidism, using other CNS depressants |
| Why do you not give opioids to a pt with a head injury? | opioids suppress respiration and increase CO2 of the blood, which will raise ICP more. |
| Mydrasis | pupil dilation |
| Meiosis | pupil constriction |
| What is the name of an opioid agonist? | Narcan (Naloxone)-- short duration so watch patient after it wears off. |
| Symptoms of opioid withdrawl include | rhinorrhea, lacrimation, yawning, chills, hyperventilation, hyperthermia, mydriasis, vomiting, diarrhea, anxiet (all are PNS symptoms) |
| When giving opiods, watch the respiratory rate. It should always be above ____. | 12 breaths per minute |
| When giving demoral, keep in mind that ____ | the build up of active metabolites can cause CNS stimulation, numbness, twitching, confusion, seizures, esp. in patients with decreased renal function |
| What are some uses of mixed agonist/antagonist opioids? | given for mild pain, reverses or blocks action of agonists, and useful in treating drug-free addicts. Does NOT cause euphoric effects!!! |
| Non-narcotic analgesics are used for | mild to moderate pain associated with inflammation and dull aches. It inhibits prostoglandin synthesis. |
| Prostoglandins are associated with | tissue inflammation |
| What is a difference in uses between NSAIDs and acetominophin. | NSAIDS like ibuprofin and asprin control pain and inflammation. Acetominophen controls fever and pain but is not an anti-inflammatory. |
| What is given as an antidote after too much acetoaminophen is given? | Mucomyst (N-acetylsysteine), most effective after 8-10 hours, and up to 17 doses are given. |
| What is the most acetaminophen that should be taken in one day? | 4 grams |
| What are some SE of ibuprofin? | stomach upset, leukopenia, NA and H2O retention. It works to inhibit prostoglandin release |
| Before giving toradol, the nurse must check ____ | renal function |
| Why is cytotec prescribed with NSAID's? | It is a synthetic prostoglandin that reduces the production of stomach acid and protects the stomach lining. It counteracts the cox-1 inhibition and reduces ulcers in people who are taking NSAIDs. |
| How do bulk forming laxatives work? | absorb water into feces to produce large, soft stools. Increasing the mass of the stools stimulates peristalsis. |
| How do lubricants work? | soften and lubricate stool (mineral oil). Also act as stool softeners, stop water absorption, makes stool slippery. Works in 1-3 days. |
| How do stool softeners work? | provide moisture to stool. Reduces surface tension in the bowel, increasing water absorption into stool. |
| How do stimulants work? | Accumulates water and stimulates the intestinal wall, producing an increase in peristalsis. |
| How do saline laxatives work? | Draw water into colon |
| Examples of bulk laxatives | bran, psyllium (metamucil), Methyl Cellulose (Citrucel), and Fibercon |
| What laxative is the only one that is safe for long-term use? | Bulk laxatives. However, dependencies can be formed with chronic use. |
| What is one disadvantage of lubricant laxatives? | Interferes with absorption of Vit K and other oil-based vitamins/minerals. |
| Examples of stimulant laxatives, and Side effect | Dulcolax, perl colace, castor oil, senna. Cramping, bloating, gas are side effects. |
| How do saline and osmotic laxatives work? | Increases water in the content of feces, resulting in distension, which stimulates peristalsis and evacuation. Makes bowel contents hypertonic. Works in 2-6 hours. |
| What laxative is also used for cirrosis of the liver? | Lactulose (Cephulac)- it binds to ammonia, which builds up in cirrhosis patients. |
| What laxative must be used cautiously for those with renal impairment? | MOM- there is a potential for hypermagnesemia due to reduced renal excretion |
| docusate sodium (colase): class | fecal softener, emollient laxative |
| glycerin suppository: class | hyperosmotic laxative |
| lactulose: class | disaccharide, hyperosmotic laxative |
| magnesium citrate (epsom salts): class | saline laxative |
| methylcellulose (citrucel): class | bulk-forming laxative |
| mineral oil: class | emollient laxative |
| polyethylene glycol (GoLYTELY): class | emollient laxative |
| psyllium: class | bulk-forming laxative |
| senna: class | stimulant-irritant laxative |
| How do antidiarrheals work? 3 types | 1) Adsorbents, attaches to toxin and is passed out with stool 2) anticholinergenics (anti-motility) 3) Opioids 4) Intestinal flora modifiers |
| Examples of adsorbent anti-diarrheals | pepto-bismol, kaolinpectin, activated charcoal, attapulgite |
| Examples of anticholinergenic antimotility drugs for diarrhea | belladonna, atropine, hyoscyamine, hyoscine |
| examples of opiod anti-diarrheal drugs | paragoric, opium tincture, codeine, loperamide (OTC), diphenoxylate |
| explain the drug diphenoxylate with atropine | is combined with subtherapeutic doses of atropine, which will result in anticholinergic effects in large doses. This discourages abuse. |
| Use antidiarrheal drugs with caution if also taking ___ | anticoagulants- especially the asprin-based ones. Can increase bleeding and clotting times |
| What are some considerations when taking adsorbent anti-diarrheal drugs? | they decrease the absorption of many drugs including digoxin, clindamycin, guinidine, hypoclycemic drugs, others |
| anticholinergenic anti-diarrheals should not be given to ___ | pts with hx of narrow angle glaucoma, BPH, urinary retention, recent bladder surgery, cardiac problems, myasthenia gravis |
| Anti-emetics will often have (2) side effects | anticholinergenic, and extrapyramidal |
| Explain extrapyramidal effects | acute dystonia: spasms of muscles of tongue, face, neck, or back. Involuntary upward deviation of eyes, tetanic spasms of the back that cause the person to arch forward. |
| Phenergen | used as a motion sickness drug, anti-emetic. |
| Hydroxyzine (Vistaril, Atarax) | used for nausea, sedation, antipruitic, and adjunct for narcotics |
| 5-HT2 antagonists | antiemetic, serotonin. Zofran, Anzement |
| What are H2 antagonists? | reduce acid secretion in stomach. Block histamine at the H2 receptor cells. |
| What is a drug interaction of cimetidine? | This H2 blocker binds with P450 resulting in increased drug levels of other drugs that could be taken at the same time. Smoking has been shown to decrease H2 blocker effectiveness. |
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AmericanChai
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